早期食管癌及癌前病变浸润深度的危险因素分析  

Risk factors analysis of early esophageal cancer and precancerous lesion invasion depth

作　　者：崔逵 蒲柯 饶星宇 李娟[1] 罗婷 杨国栋[1,2] CUI Kui;PU Ke;RAO Xing-yu;LI Juan;LUO Ting;YANG Guo-dong(Department of Gastroenterology,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;Medical Imaging Key Laboratory of Sichuan Province,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]四川省南充市川北医学院附属医院消化内科,637000 [2]四川省南充市川北医学院附属医院医学影像重点实验室,637000

出　　处：《现代消化及介入诊疗》2023年第10期1209-1213,共5页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：国家自然科学基金(81960430);四川省南充市市校合作科研专项(18SXHZ0371)。

摘　　要：背景食管癌(esophageal cancer, EC)的发病率及死亡率居仍高不下,早期评估病变侵袭深度对治疗及预后具有重要意义。目前,分析浸润深度的方式以内镜下血管分型为主,但准确评估的方法仍需进一步探索。目的 探讨与早期EC及癌前病变浸润深度有关的因素。方法 收集2019年11月至2023年10月于四川省南充市川北医学院附属医院行内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)治疗且术后病理诊断为早期EC及癌前病变患者资料。分析不同浸润深度患者的临床、内镜及组织病理学特征有无差异。结果 在287例早期EC及癌前病变患者中,肿瘤累及M1患者165例(57.5%)、M2者79例(27.5%)、M3者34例(11.9%)及SM1者9例(3.1%)。在多因素分析结果中,IPCL分型(OR 3.854, 95%CI 2.123~6.994)、肿瘤长度>3 cm(OR 2.489, 95%CI 1.514~4.096)、大体分型0-Ⅱb(OR 0.422, 95%CI 0.180~0.989)及合并白色苔藓样变(OR 2.016, 95%CI 1.220~3.327)与早期EC及癌前病变患者浸润风险的显著相关。进一步亚组分析显示,在不同肿瘤长度的人群中,白色苔藓样变均是浸润深度的独立危险因素,尤其是肿瘤长度≤3 cm(OR 2.300, 95%CI 1.059~4.998)。并且,合并白色苔藓样变的IPCL-B1型、0-Ⅱb型患者,肿瘤浸润风险明显增大(P=0.006;P=0.024)。结论 IPCL分型、肿瘤长度及白色苔藓样变与早期EC及癌前病变浸润深度呈正相关,0-Ⅱb型肿瘤浸润风险较低。并且,当存在白色苔藓样变时,IPCL-B1型、0-Ⅱb型或长度≤3 cm的患者肿瘤累及更深层次的风险更大。Background In recent years,the incidence and mortality rates of esophageal cancer(EC)have remained high.Early assessment of the depth of tumor invasion is of great significance for treatment and prognosis.Currently,the analysis of invasion depth primarily relies on endoscopic vascular classification.However,accurate evaluation methods still need to be further explored.Objective To investigate the factors related to the depth of invasion of early EC and precancerous lesions.Methods The data of patients with early EC and precancerous lesions who underwent endoscopic submucosal dissection(ESD)in Affiliated Hospital of North Sichuan Medical College from November 2019 to October 2023 were collected.The clinical,endoscopic and histopathological characteristics of patients with different infiltration depths were analyzed.Results Among the 287 patients with early esophageal cancer(EC)and precancerous lesions,165(57.5%)had tumor involvement at depth M1,while 79(27.5%),34(11.9%),and 9(3.1%)had involvement at depths M2,M3,and SM1,respectively.In the multivariate analysis,IPCL classification(OR 3.854,95%CI 2.123~6.994),tumor length>3 cm(OR 2.489,95%CI 1.514~4.096),tumor morphology 0-Ⅱb(OR 0.422,95%CI 0.180-0.989),and co-occurring white lichenoid lesions(OR 2.016,95%CI 1.220~3.327)were significantly associated with the risk of infiltration in patients with early EC and precancerous lesions.Further subgroup analysis showed that white lichenoid lesion was an independent risk factor for depth of invasion in people with different tumor lengths,especially tumor length≤3 cm(OR 2.300,95%CI 1.059~4.998).Moreover,the risk of tumor invasion was significantly increased in IPCL-B1 and 0-IIb patients with white lichenoid lesion(P=0.006;P=0.024).Conclusion IPCL classification,tumor length and white lichenoid lesion were positively correlated with the depth of invasion of early EC and precancerous lesions,and the risk of 0-IIb tumor invasion was lower.In addition,when there is white lichenoid lesion,patients with IPCL-B1 type,0-Ⅱb typ

关 键 词：早期食管癌 癌前病变 浸润深度 危险因素 

分 类 号：R571[医药卫生—消化系统]